Provider Demographics
NPI:1619024627
Name:AUSTIN, CARL G (MA)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:G
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1160 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8421
Mailing Address - Country:US
Mailing Address - Phone:386-774-9073
Mailing Address - Fax:386-775-8044
Practice Address - Street 1:2425 S VOLUSIA AVE
Practice Address - Street 2:UNIT B-4
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7625
Practice Address - Country:US
Practice Address - Phone:407-417-3859
Practice Address - Fax:407-830-7903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health